Garth W. Strohbehn, MD, MPhil, Assistant Professor of Hematology/Oncology at Michigan Medicine
ANN ARBOR, MI — Changing modes of delivery could save the VHA millions annually on the cost of cancer immunotherapy treatments, according to a new analysis.
If vials intended for a single patient’s use are shared across patients, physicians could deliver customized doses while also reducing waste and costs, according to researchers from the University of Michigan and the VA Ann Arbor, MI, healthcare system.
The analysis published in Health Affairs suggested the concept could be applied to all cancer centers nationwide. The authors pointed out that immune checkpoint inhibitors were initially tested and approved at weight-based dosages but then moved to one-size-fits-all flat doses, partly to reduce drug waste.
“Administering drugs in flat one-size-fits-all dosages is predictable and allows for single-use vials with less drug material being discarded. This gives the appearance of less waste to the payer. But it conceals the fact that excess drug amounts may be administered to the patient, relative to what they need, which ultimately may be increasing usage and drug spending,” said senior study author Garth W. Strohbehn, MD, MPhil, assistant professor of hematology/oncology at Michigan Medicine and an early career research scientist with the VA Ann Arbor Center for Clinical Management Research.
“Immune checkpoint inhibitors, a class of drugs used in approximately 40 unique cancer indications, are a sizable component of the economic burden of cancer care in the U.S.,” according to the report. “Instead of personalized weight-based dosing, immune checkpoint inhibitors are most commonly administered at ‘one-size-fits-all’ flat doses that are higher than necessary for the vast majority of patients.”
The researchers posited that personalized weight-based combined with common stewardship efforts in pharmacies, such as dose rounding and vial sharing, would lead to reductions in immune checkpoint inhibitor use and lower spending.
To test that, the study team used data from the VHA, as well as Medicare drug prices, estimating “reductions in immune checkpoint inhibitor use and spending that would be associated with pharmacy-level stewardship strategies, in a case-control simulation study of individual patient-level immune checkpoint inhibitor administration events.”
The VHA data came from records of patients who received at least one dose of any type of immune checkpoint inhibitor from a VAMC in 2021 to create a simulation of how the drugs could be better stewarded. That included using weight-based doses and combining single-use vials across multiple patients rather than discarding any extra.
The researchers calculated baseline annual VHA spending for those drugs at approximately $537 million. Combining weight-based dosing, dose rounding, and pharmacy-level vial sharing, however, was found to generate expected annual VHA health system savings of $74 million, a 13.7% reduction.
“We conclude that adoption of pharmacologically justified immune checkpoint inhibitor stewardship measures would generate sizable reductions in spending for these drugs,” the authors advised. “Combining these operational innovations with value-based drug price negotiation enabled by recent policy changes may improve the long-term financial viability of cancer care in the U.S.”
“Evidence suggests that flat and weight-based dosing are equally effective in treating cancer. In an era of ever-rising drug prices and aging populations, adopting stewardship measures could markedly improve the cost-effectiveness of cancer care in our country,” said lead study author Alex Bryant, MD, MAS, a radiation oncology resident at Michigan Medicine.
- Bryant AK, Chopra Z, Edwards DM, Whalley AS, et. al. Adopting Weight-Based Dosing With Pharmacy-Level Stewardship Strategies Could Reduce Cancer Drug Spending By Millions. Health Aff (Millwood). 2023 Jul;42(7):946-955. doi: 10.1377/hlthaff.2023.00102. PMID: 37406228.
